MEDICARE: DR. KARRN ELIZABETH BALES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	02001676A	IN

General Provider Information

NPI Number	:	1255325593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARRN ELIZABETH BALES DO

Provider Business Mailing Address
First Line	:	9523 LOYAL VLY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4942
Country	:	US
Telephone Number	:	210-671-9556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 TRUEMPER AVE
Second Line	:
City	:	LACKLAND AFB
State	:	TX
Zip	:	78236
Country	:	US
Telephone Number	:	210-671-9556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	05/23/2008

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